Claw Toes and your Low Back

by Chris Centeno, MD /

claw toes and your low back

Is there a relationship between claw toes and your low back?  I often see patients with the dreaded “claw toes”. They’re usually middle aged or older and like the picture above, their 2nd through fifth toes have begun to look like a claw. Why? These toes look exactly like what we call an “intrinsic minus hand” that are seen in quadriplegic spinal cord injury patients. This claw hand happens after the muscles that live in the hand (called intrinsic muscles) atrophy and get weak, reducing their pull on certain parts of the 2nd through 5th fingers and allowing a muscle imbalance to occur. I believe the same is happening in the foot, but not quickly due to a sudden cutting of the nerves to the intrinsic foot muscles (like a spinal cord injury), but much more slowly. To support the concept that this same thing is known to happen slowly, we know that diabetic patients get atrophy of their intrinsic foot muscles after their nerves get bad and that this can lead to claw toes. However my patients with claw toes aren’t diabetics. What’s less studied is what happens when someone has low level spinal nerve irritation in the their low back for years. The spinal nerves are those that exit the spinal cord and then turn into bigger leg nerves that then supply the muscles of the lower extremity. What I’ve noted over many years is that the toes of patients with chronic S1 spinal nerve problems take on this claw foot appearance. These patients may or may not have active low back pain at the time I’m seeing them, but they usually have a constellation of symptoms and problems through the years that are all S1 spinal nerve related. This long list includes: Achilles tendinitis, plantar fasciitis, tightness and fatigue in the calf muscles, cramping in the foot, pain on the outside of the ankle, knee, or hip. They can also have chronic pain or tightness in the hamstrings or back of the knee. These patients don’t have all of these symptoms at the same time and some may not have many of them, but all of these complaints are the types of symptoms associated with chronic S1 spinal nerve irritation. What’s this caused by? It’s usually a central bulge at the L5-S1 low back disc that irritates the descending S1 nerve. In addition, we’ve also seen it caused by a single event of severe low back pain that causes significant atrophy of the multifidus stabilizing muscles in the low back. With these muscles off line, the L5-S1 spinal segment becomes sloppy and this leads to S1 nerve root irritation (this is discussed further in the Orthopedics 2.0 book). Do you have a case of the dreaded claw toes and also have any of the above symptoms? For example, if you have chronic pain on the outside of your hip and have been told you need a hip replacement, but have these claw toes as well? Your hip pain may not be primarily caused by your hip arthritis, but instead the S1 nerve in your back. The same holds true for outside knee or ankle pain with arthritis, Achilles tendonitis, and/or plantar fascitis. Is it hard to believe that you really have a back nerve issue causing pain in these distant areas when you really don’t feel like you have a back problem? Believe it – as we see it every day. The upshot? Look down at your feet to see what may be causing your lower extremity pain!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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